Why vaccination is so important. Answered in questions.
I put out a call for questions about the vaccines and vaccinations. I got many great questions and so I thought I would put up a Q&A post. What I say below is my best understanding of the current situation. When I talk about vaccines, I am focused on the United States and am specifically referring to the trio of Pfizer, Moderna, and Johnson & Johnson. These answers are quick and dirty. Please let me know if you’d like more information on any particular topic.
What are basic reasons to get vaccinated?
Vaccination radically reduces your own risk of getting sick even from the known variants.
Vaccination slows the spread of the virus, which keeps the prevalence of COVID-19 low, which means we can get back to whatever the new normal is / will be.
Extensive vaccination keeps COVID-19 from reaching those who can’t be vaccinated like children and immunocompromised individuals.
Extensive vaccination reduces the rate of mutation of the virus making it less wily.
Extensive vaccination makes it easier for our community to spot and deal with breakthrough cases and variants.
What are breakthrough COVID-19 cases? Cases of COVID-19 that occur in individuals who have been vaccinated.
You should know that while the vaccines are incredibly effective, there are cases of people catching COVID-19 despite having been vaccinated. Many of these cases are being observed in individuals who haven’t gone through the complete vaccine protocol. For example an individual might get sick within the two weeks of their second dose of a Pfizer or Moderna vaccine. However there are definitely cases of fully vaccinated people getting sick and even dying. These cases are incredibly rare but they have happened. Vaccines don’t eliminate the risk of COVID-19 instead they bring it’s risk down to a level much closer to all the other day by day risks we are used to living with.
Do the vaccines work against variants? Yes
These vaccines are modern miracles with incredible efficacy rates. If you take a vaccine that is amazingly efficacious and weaken it a bit, it is still incredibly efficacious. The J&J vaccine is 85% effective against the original strain of COVID-19 at the prevention of severe COVID-19. This barely drops to 82% against the B.1.351 South African variant. The same detailed studies don’t exist for Pfizer and Moderna, but their efficacy against the original strain starts even higher, at 95% effective. So even if the efficacy drop for these other vaccines against the South African variant was as much as 13 percentage points it would still be a damn effective vaccine.
https://www.nytimes.com/2021/04/15/well/live/covid-variants-vaccine.html
Would you worry about getting the J&J vaccine? Emotionally yes. Intellectually absolutely not.
In this fight against COVID-19 we need every bit of ammunition we have and the J&J vaccine is a superb part of this arsenal. It is a great vaccine which has a lot going for it, specifically easy storage and only one shot. We would ideally use it for hard to reach populations. It is a shame that the J&J vaccine has this bit of shade thrown on it, so let’s shine a little light.
First off, the blood clotting issue is a real concern. The women who had these blood clots were not people at risk for blood clots. Furthermore, the blood clots were associated with low platelet level which if you know anything about blood clots is quite bizarre and has implications for how these blood clot side effects should be treated by doctors.
With that said, these clots are incredibly rare. They are so rare that if you drive more than one mile round trip to get your J&J shot then you have a greater chance of dying in a car crash on your way to and from your appointment than you do of dying from a blood clot from the vaccine. You do things every day that put your life at risk way more than getting a J&J jab.
Of course, this intellectual rationalization only goes so far with my limbic system, but that’s why I have a frontal cortex to be able to make a rational choice. If I was in Michigan, India, or Brazil, for instance, I would be jumping up and down and screaming for a dose of the J&J vaccine. It’s easy to sit here and be selective in a country that’s hogging all the vaccine supply for itself, but as I mentioned at the start this is an incredibly effective and very safe vaccine and it needs to be deployed now to whomever will take it.
Why should I get a foreign substance (the vaccine) injected into my arm? Won’t the vaccine stay in my body forever? Vaccines are designed to be expunged from your body. The virus that causes COVID-19 is self replicating and it could stick around in your system forever.
I was listening to the following podcast in which a Republican pollster was trying to get Republican people to get vaccinated and the above fact really struck me as a powerful bit of information that could be used with anti-vaxers from both the extreme left and extreme right.
https://www.thisamericanlife.org/736/the-herd/act-two-2
Vaccines are designed to elicit an immune response from your body and then to be metabolized by your body and effectively disappear from your system. SARS-CoV-2 the virus that causes COVID-19 in contrast can spread to all parts of your body and can replicate in all parts of your body and can persist in many parts of your body. We know that Long-COVID exists and it might exist in some people because their bodies have gotten rid of much of the virus but their immune systems haven’t been able to reach all the virus reservoirs. I remember reading a report about an individual with an Ebola reservoir in his eye. He had survived Ebola and was living a normal life but his ongoing symptoms led the doctors to realize that the Ebola virus was hiding out in his eye. That story alone creeps me out enough to get me over any vaccination phobia that I have.
https://www.theatlantic.com/health/archive/2016/03/ebolas-hidden-impact-on-the-eye/475992/
What is the difference between an Emergency Use Authorization (EUA) and full FDA approval? Mostly but not entirely bureaucratic.
The answer to this question comes from a friend who’s an MD/PhD.
The main hurdles to get full FDA approval are fairly perfunctory:
1. A longer follow up period to see if there are long term side effects. Perhaps a few more months.
2. More details on manufacturing processes and robustness of the supply chain that take time for the the company to produce, but are fairly mundane.
Government entities cannot require/mandate vaccines that just have an EUA, but can if fully FDA approved. Currently, under the EUA, state universities cannot mandate vaccines for their students. Private universities could mandate vaccination.
An EUA is more easily revocable than a full FDA approval. For example, EUA are often given when the benefits greatly out weigh the risks, perhaps because of a transient event like the shortage of another medicine (or a pandemic!) If the shortage of the other medicine is resolved, the EUA might be revoked even though nothing regarding risk and efficacy changed with respect to the medication granted the EUA.
I believe that the Phase 1, 2, and 3 trials for the COVID-19 vaccines currently in use involved just as many people (if not more) than are typically used for full FDA approval. And by this point in time the COVID-19 vaccines have now had much more exposure than vaccines would normally have had to get full FDA approval. The relatively recently FDA approved vaccines for shingles hadn’t been given to millions of people before they got full FDA approval. One of the reasons that we’re catching very rare side effects is because vaccine use is so widespread.
I do not know how long the FDA will wait to see whether there are long term side effects before granting full approval. In the case of the shingles vaccines the study period ranged from 1 year to 3 years. The one year follow up period will be complete this summer for the trio of vaccines currently in use and given the dire nature of this emergency I doubt the FDA is going to wait 3 years to grant full authorization.
Should I worry about the variants? Not now but perhaps long term.
Looking back, we saw the growth and spread of COVID-19 in early 2020 and had a month or two to respond. Similarly, we will be able to spot variants that significantly breakthrough vaccination by watching the trends in the US and around the world. We will have some warning. We are looking for a situation where significant numbers of vaccinated people are being hospitalized because of a particular variant.
It will be easier to spot this kind of trend if we have a lot of people vaccinated. A low local prevalence means that a problematic variant will almost certainly come from outside our community. This in turn means that we should be able to spot it in other communities before it comes here and furthermore it will stick out like a sore thumb when it does come here.
That said, with the absolutely crazy surges happening in India and Brazil right now, I am concerned for the future. The virus is reproducing itself so many times in so many people right now that there are vast numbers of mutations testing themselves against humanity. Every mutation is a trial in which COVID-19 has a chance to further hone itself, getting better at infecting and perhaps getting better at evading vaccines. While I hope that we don’t, I could see us having another wave of COVID-19 due to a variant sometime in the future.
When can children get vaccinated? Depends on age.
Vaccine development proceeds from adults, to teenagers, to older children, to younger children, to very young children. It sounds as if a critical part of adapting a vaccine to children is getting the dosage right. Gauging the dosage becomes harder as the children get smaller and more different from adults.
Much of the work has already been done for children 12 and older. In fact, Pfizer submitted test results for this age range and it’s looking like they should be able to get vaccinated sometime in the summer. I’m keeping my fingers crossed, as this will mean that my current high school freshman will have a much more normal in person sophomore year.
Children 5 to 11 will probably be approved by the end of 2021 or early 2022. The youngest group is less certain but may be able to get vaccinated around the beginning of 2022.
https://www.scientificamerican.com/article/when-will-kids-get-covid-vaccines/
What is safe and reasonable to do when parents are vaccinated but not kids? Depends.
This depends a lot on your family’s tolerance for risk, but know that COVID-19 presents a risk to children that is similar to seasonal flu. The risk is not zero, but it is similar to a risk that we’ve been living with for years before this. The other factor is that your child can spread COVID-19 to unvaccinated people and keep the virus circulating.
Every activity that your kid engages involves some risk of exposure. I would make sure that activities with greatest risk of exposure are beneficial to the child. To me going to school and playing sports are obviously activities where the benefit significantly outweighs the risk. I’m not planning to eat inside a restaurant with my kids for the next couple of months, because the risk isn’t worth the benefit.
Taking a child on a flight to see relatives and friends might be a reasonable risk. But that might depend on how crowded the flight was and how many people are wearing masks on the flight.
An unmasked indoor play date could also go either way. I could see doing this in a month or so, if cases continue to remain low. I would probably still limit these indoor affairs to just one or two kids. I certainly wouldn’t go hosting an indoor unmasked birthday party.
https://www.nytimes.com/2021/04/22/opinion/covid-vaccine-kids.html
If vaccines are so effective, do we still need testing? Absolutely.
As you might infer from the answers above, testing is needed for surveillance to keep an eye on what’s happening and to make sure that there’s no breakthrough cases of COVID-19.
Testing is obviously critical in hospitals and won’t be going away there any time soon. Many of the breakthrough cases we know about today are from hospital workers and/or other professions that are getting tested on a regular basis whether they have symptoms or not.
Testing is also critical for those communities that haven’t been vaccinated yet. In particular, we should have a good testing plan for our schools. Ideally, rapid tests would be available for any kids that have any sort of sniffles or other symptoms. Children are often asymptomatic and so using rapid tests for randomly sampled surveillance at schools would be another good use of tests.
Do we still need to wear masks outdoors? No but yes.
My hesitancy with doing away with outdoor mask requirements is that it erodes mask compliance everywhere else its needed. We still need masks indoors and masks remain useful outdoors amongst a group of people in close quarters for an extended period of time. I like seeing masks on people outdoors because it reminds me that we’re still in a pandemic and it also reminds me that we’re all in this together. And if I really stop to think about it, it warms my heart that people out there are wearing a mask to protect me even if they don’t know me.
By the way CDC guidelines say that a group of fully vaccinated people can get together without masks and that still holds true here. My guidelines above are referring to groups of strangers inside and outside.
https://www.nytimes.com/2021/04/22/well/live/covid-masks-outdoors.html
If the Chinese vaccine is not great, why are the numbers so low in China? They never needed a vaccine to control the virus in the first place.
China, New Zealand, Korea, and a few other countries have been able to keep the circulation of the virus at very low levels without the use of any vaccines. These countries have used lockdowns and have used testing, contact tracing, and supported isolation (TTSI) in a way that San Francisco (much less the US) can only dream about. All of these countries’ programs put us to shame. Part of the reason I supported and partnered with the Latino Task Force and Unidos en Salud is that these organizations were the only ones that came close to achieving what these countries did. Unfortunately it was only in the later part of this most recent third wave that these organizations started to get the support that they really needed to suppress the virus without having to resort to vaccinations.
I must add that China has the benefit of both having a totalitarian system and also has the benefit of recent experiences with large scale epidemics. New Zealand and Korea have the benefit of effectively being islands which helps them isolate.